45y female presents to Cath Lab following several syncope ep | Figure 1

Firstvictor
Technologist

45y female presents to Cath Lab following several syncope episodes over the past few months and failing treadmill test as there was noted inferior EKG changes consistent with ischemia. Pt is post aortic valve replacement 10 years prior for reason unknown to technologist. Left heart cath performed reveals severe aortic oss aneurysm. RCA was unable to be cannulated requiring super valvular aortogram to visualize. Of note - chest CT performed following cath, showed invaginated area of oss distinct and separate from aneurysm where RCA take off is. CT unavailable. White arrow denotes left main, black RCA takeoffs. Pt scheduled for open heart aortic surgical repair and possible valve replacement in two weeks time at higher level facility.

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